A feasibility study (ICG-10) of indocyanine green (ICG) fluorescence mapping for sentinel lymph node detection in early breast cancer

Navigation surgery for intraoperative sentinel lymph node detection using Indocyanine green (ICG) fluorescence real-time imaging in breast cancer

“…Furthermore, NIR fluorescence imaging can provide a surgical view on the monitor for orientation of the surgical procedure. Indeed, NIR fluorescence-guided SLN mapping has been extensively studied in breast surgery [18][19][20][21][22]. To date, these studies have demonstrated the feasibility of NIR fluorescence imaging during surgery.…”

“…In contrast, the combination of both methods results in an SLN identification rate of more than 90 %, and the accuracy ranges from 65 to 98 % [15,16]. Recently, it has been shown that fluorescence imaging enables transcutaneous real-time lymphography and intraoperative lymph node detection with an acceptable sensitivity and specificity that is comparable to radiocolloid and blue dye methods [17][18][19]. Indocyanine green (ICG) fluorescence was visualized by collecting near-infrared (NIR) rays and rejecting visible light because the use of conventional fluorescence imaging systems is usually associated with some limitations, including dimmed lighting conditions and the disruption of surgical procedures to search for SLNs and lymphatic vessels [20][21][22].…”

New Technologies in Breast Cancer Surgery

“…The signal remains in the tissue for only 30 min, which leads to a quick detection of the SLN. Recently published data has shown an excellent detection rate for ICG alone of 100%, ICG and blue dye of 95.0%, ICG radioisotope of 77.2%, and ICG and blue dye and radioisotope of 73.1% [18]. Another study presented a detection rate for ICG of also 100% [19].…”

Development of a handheld fluorescence imaging camera for intraoperative sentinel lymph node mapping

“…[15][16][17] Compared with the conventional methods, similar to slightly better detection rates were achieved. 8 In addition, the SLN detection with ICG has been successfully reported in various cancers where lymphatic flows are multidirectional and complex, e.g., gastric cancer [18][19][20][21] and colorectal cancer, 22,23 as well as in different gynecological cancer types located in vulva, [24][25][26] cervix, 9,25,27 or endometrium. [28][29][30] To our knowledge, there are several investigational devices used for clinical trials of ICG fluorescence imaging of SLNs in humans: the Photodynamic Eye from Hamamatsu, 11,19 the ICView from Pulsion Medical Systems, 10,23 the FLARE system developed at Beth Israel Deaconess Hospital in Boston, Massachusetts, 6 a prototype developed at the Helmholtz Zentrum of the Technical University Munich, Germany, 31 the SPY imaging system (Novadaq Technologies Inc., USA), 17 the low-cost ICG fluorescence detection system built at University of Tsukuba in Japan, 32 and the frequency-domain photon migration imaging system developed at the University of Texas Health Science Center in Houston, Texas.…”

“…3 The clinical studies where ICG was used in NIR fluorescence-guided cancer surgery have been recently reviewed. 2,4,5 Although ICG has not yet been approved for SLN mapping in the US and in Europe, there are numerous publications on clinical trials on humans, where ICG was used as a fluorescent agent for SLN detection for patients with breast cancer [6][7][8][9][10][11][12][13][14] and skin cancer. [15][16][17] Compared with the conventional methods, similar to slightly better detection rates were achieved.…”